Beyond the Eyes: Is Teprotumumab Effective for Thyroid Dermopathy?

Pretibial dermopathy (PTD) is a rare, disfiguring manifestation of Graves' disease. The shared pathophysiology with thyroid eye disease (TED), centered on fibroblast activation via a thyroid-stimulating hormone receptor and insulin-like growth factor-1 receptor (IGF-1R) complex, provides a strong rationale for using the IGF-1R inhibitor, teprotumumab.

We present a case series of five patients with severe PTD and concomitant TED who were treated with teprotumumab. A review of reported cases in the literature was also conducted.

All patients experienced significant clinical improvement, including regression of skin thickening as well as enhanced functional capacity. Side effects included mild hearing loss, muscle cramps, and fatigue. One patient experienced a severe gastrointestinal event requiring treatment discontinuation, while those experiencing a recurrence of PTD, responded to a second course of therapy.

Teprotumumab showed promising efficacy in the treatment of PTD. Further studies are needed to confirm its durability and safety.